Persistent cough for two weeks leads to shocking diagnosis of severe triple vessel coronary artery disease

Initially thought to be a persistent cough, a 55 year old man from Taiwan was unexpectedly diagnosed with heart failure and severe triple vessel coronary artery disease, carrying a high risk of sudden cardiac death if not promptly detected and treated.

From mild symptoms to a serious diagnosis

Mr H.W.Y presented to Hong Ngoc General Hospital with a persistent dry cough lasting for two weeks that did not improve despite medication. In recent days, he also developed additional symptoms, including shortness of breath when lying down, exertional fatigue, and bilateral lower limb edema.

Medical history revealed multiple cardiovascular risk factors, including untreated hypertension, type 2 diabetes mellitus, long term smoking, and chronic alcohol use. Based on these findings, physicians suspected underlying cardiovascular disease and recommended coronary angiography.

The angiography results were shocking, even to the patient, revealing severe stenosis in all three major coronary arteries, with multiple lesions exceeding 90% narrowing and extensive calcification. The coronary artery calcium score on computed tomography exceeded 1,000, indicating a very high burden of calcification.

This condition carried a significant risk of acute myocardial infarction at any time if not promptly treated.

“I thought it was just a common cough. I never expected to be diagnosed with such a serious heart condition,” Mr. Y said.

Advanced techniques successfully manage complex lesions

Dr. Nguyen Dinh Cong, MD, MSc - Deputy Head of the Department of Cardiology and Interventional Cardiology at Hong Ngoc Phuc Truong Minh General Hospital, commented on the case of Mr H.W.Y: “This was a challenging case involving diffuse, multi segment lesions, particularly at coronary bifurcation sites, where blood flow divides into multiple branches, making intervention more complex than in typical locations. To ensure patient safety, the medical team decided to perform the procedure in two stages rather than addressing all lesions in a single session.”

During the first intervention, physicians performed balloon angioplasty followed by placement of two consecutive stents at a 90% stenosis in the left anterior descending artery, a critical vessel, in order to rapidly restore blood flow and reduce the risk of myocardial infarction.

Intravascular ultrasound (IVUS) was utilized during the procedure to accurately assess the location and characteristics of the lesions. Post intervention results showed that blood flow was effectively restored.

Two weeks later, the patient underwent a second intervention to address the remaining lesions. During this procedure, the team applied a hybrid strategy, combining drug coated balloon angioplasty with stent placement at a distal coronary bifurcation lesion in the right coronary artery.

This approach helped reduce the number of stents required, thereby lowering the long term medication burden while still ensuring effective coronary revascularization.

According to Dr. Cong: “The patient had diffuse stenotic lesions with significant calcification, particularly at a tight, angulated bifurcation site, which made guidewire crossing technically challenging. The use of a hybrid strategy not only helped reduce the number of implanted devices but also minimized the risk of stent overlap, a factor associated with increased risks of restenosis and in stent thrombosis, while still ensuring stable and durable coronary blood flow.”

Following the two interventions, Mr. Y’s condition improved markedly, with reduced shortness of breath, no chest pain, and near normal mobility. He was discharged just three days after the procedure.

“I have been living and working in Hanoi, so I was already familiar with Hong Ngoc. I felt completely confident receiving treatment here. The doctors were very dedicated, and the quality of care was comparable to that in Taiwan,” Mr Y said before discharge.

Doctors advise that seemingly mild symptoms such as a persistent cough of unknown cause, shortness of breath, exertional fatigue, or leg swelling may be warning signs of serious cardiovascular disease. Early medical evaluation plays a crucial role in timely diagnosis and in preventing severe complications.

The Department of Cardiology and Interventional Cardiology at Hong Ngoc General Hospital, with its team of experienced interventional specialists and modern medical equipment, is a trusted destination for the diagnosis and treatment of complex cardiovascular conditions.

The hospital also accepts a wide range of insurance plans, including public health insurance and private insurance, helping patients optimize treatment costs.

Address: 

• No. 8 Chau Van Liem Street, Tu Liem Ward, Hanoi 
• No. 55 Yen Ninh Street, Ba Dinh Ward, Hanoi
• Hotline for consultation: +84 911 858 626

Initially thought to be a persistent cough, a 55 year old man from Taiwan was unexpectedly diagnosed with heart failure and severe triple vessel coronary artery disease, carrying a high risk of sudden cardiac death if not promptly detected and treated.

From mild symptoms to a serious diagnosis

Mr H.W.Y presented to Hong Ngoc General Hospital with a persistent dry cough lasting for two weeks that did not improve despite medication. In recent days, he also developed additional symptoms, including shortness of breath when lying down, exertional fatigue, and bilateral lower limb edema.

Medical history revealed multiple cardiovascular risk factors, including untreated hypertension, type 2 diabetes mellitus, long term smoking, and chronic alcohol use. Based on these findings, physicians suspected underlying cardiovascular disease and recommended coronary angiography.

The angiography results were shocking, even to the patient, revealing severe stenosis in all three major coronary arteries, with multiple lesions exceeding 90% narrowing and extensive calcification. The coronary artery calcium score on computed tomography exceeded 1,000, indicating a very high burden of calcification.

This condition carried a significant risk of acute myocardial infarction at any time if not promptly treated.

“I thought it was just a common cough. I never expected to be diagnosed with such a serious heart condition,” Mr. Y said.

Advanced techniques successfully manage complex lesions

Dr. Nguyen Dinh Cong, MD, MSc - Deputy Head of the Department of Cardiology and Interventional Cardiology at Hong Ngoc Phuc Truong Minh General Hospital, commented on the case of Mr H.W.Y: “This was a challenging case involving diffuse, multi segment lesions, particularly at coronary bifurcation sites, where blood flow divides into multiple branches, making intervention more complex than in typical locations. To ensure patient safety, the medical team decided to perform the procedure in two stages rather than addressing all lesions in a single session.”

During the first intervention, physicians performed balloon angioplasty followed by placement of two consecutive stents at a 90% stenosis in the left anterior descending artery, a critical vessel, in order to rapidly restore blood flow and reduce the risk of myocardial infarction.

Intravascular ultrasound (IVUS) was utilized during the procedure to accurately assess the location and characteristics of the lesions. Post intervention results showed that blood flow was effectively restored.

Two weeks later, the patient underwent a second intervention to address the remaining lesions. During this procedure, the team applied a hybrid strategy, combining drug coated balloon angioplasty with stent placement at a distal coronary bifurcation lesion in the right coronary artery.

This approach helped reduce the number of stents required, thereby lowering the long term medication burden while still ensuring effective coronary revascularization.

According to Dr. Cong: “The patient had diffuse stenotic lesions with significant calcification, particularly at a tight, angulated bifurcation site, which made guidewire crossing technically challenging. The use of a hybrid strategy not only helped reduce the number of implanted devices but also minimized the risk of stent overlap, a factor associated with increased risks of restenosis and in stent thrombosis, while still ensuring stable and durable coronary blood flow.”

Following the two interventions, Mr. Y’s condition improved markedly, with reduced shortness of breath, no chest pain, and near normal mobility. He was discharged just three days after the procedure.

“I have been living and working in Hanoi, so I was already familiar with Hong Ngoc. I felt completely confident receiving treatment here. The doctors were very dedicated, and the quality of care was comparable to that in Taiwan,” Mr Y said before discharge.

Doctors advise that seemingly mild symptoms such as a persistent cough of unknown cause, shortness of breath, exertional fatigue, or leg swelling may be warning signs of serious cardiovascular disease. Early medical evaluation plays a crucial role in timely diagnosis and in preventing severe complications.

The Department of Cardiology and Interventional Cardiology at Hong Ngoc General Hospital, with its team of experienced interventional specialists and modern medical equipment, is a trusted destination for the diagnosis and treatment of complex cardiovascular conditions.

The hospital also accepts a wide range of insurance plans, including public health insurance and private insurance, helping patients optimize treatment costs.

Address: 

• No. 8 Chau Van Liem Street, Tu Liem Ward, Hanoi 
• No. 55 Yen Ninh Street, Ba Dinh Ward, Hanoi
• Hotline for consultation: +84 911 858 626